I am concerned about stiffness in the first joint at the base of the big toe

What happens following an MTPJ operation?

These types of surgery are usually performed either as a day-case or with a brief overnight stay in hospital. After the operation you will wake up with your foot in a bandage. The foot can be painful but it is usually possible to control the pain with oral medication. In order to minimise swelling, you will need to keep your foot raised up for the two weeks following the operation.

How long does it take to recover?

Immediately following the operation you will need to rest with your foot up most of the time. If the foot is lowered for any time it will throb and swell and this should therefore be minimised. With time, the period you can keep the foot down will increase. After two to three weeks, you should be able to keep it down most of the time. About two weeks after surgery you will return to the clinic for removal of stitches or a simple wound check. Following this, your recovery will depend on your own circumstances and on the operation you had.

Cheilectomy: After cheilectomy you will start your exercises to mobilise the foot.

Fusion: On average, you should expect to spend six to eight weeks in a post-operative shoe or cast. After this, you will need a trainer-type shoe or open toed sandal, preferably with adjustable straps. It will be a further six to eight weeks before you can wear a standard shoe for a working day. It is usually three to six months from the operation before you can hope to resume recreational walking or light sporting activities. In the longer-term, many patients will be able to run and participate in sports after a fusion, but this cannot be guaranteed. If your recovery takes longer than these times, do not panic as these figures are only averages. However, you should let your surgeon know about any concerns you might have when you attend the clinic.

What are the potential complications / risks after a fusion operation?

Although the operation has a very good success rate, complications can occur.
Problems can include:
1. Non-healing of the bone following fusion (occurs in about one in 20 people) and may require further surgery. Smoking increases the risk of this complication considerably.
2. The position in which the toe is set following fusion can also cause problems. Women may find that they cannot wear high heels after a fusion. A few people will find that the position in which the toe is set does not suit them individually and may consider further surgery to adjust this.
3. Sensitisation of the foot due to damage to the small nerves and blood vessels.
4. Weight transfer to the second toe (a corn under the second toe).
5. Infection.
6. The complications of any surgery such as thrombosis (a blood clot) and anaesthetic problems.

Most complications can be treated with medication, therapy and, on occasions, by further surgery. However, surgery of this kind should not be undertaken lightly; the symptoms you are suffering with should be sufficiently troublesome to warrant the inconvenience and small risks inherent in having the surgery. For this reason, we do not advise surgery for cosmetic reasons or to avoid problems that are not yet present. You can reduce the risk of complications by preparing yourself and your foot as described in our information ‘preparing for foot surgery’. If you are at particular risk of complications, this will be discussed with you. If you have any general or specific worries you should ask the doctor treating you.

How do I know if I have a complication?

Some problems such as recurrence of the bump or corn formation become obvious with time. It is important that you notify a doctor if you get an increase in pain after you go home and particularly, if the pain does not settle with elevation and mild painkillers, as this may indicate early infection. Similarly, if you get swelling of the leg or foot which does not go away when the foot is elevated above heart level, you should seek medical advice immediately.

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